Tue, 10 Oct 2017 13:07:26 -0700WeeblyMon, 17 Mar 2014 16:19:01 GMThttp://www.jennahaines.com/blog/st-patricks-day-in-hobokenA Note: This piece was originally in NYU's Inquiring Minds blog on March 7, 2011 and is being re-published by the author in celebration of St. Patrick's Day. Parties in balcony peer over Washington Street

Washington Street spewed green this Saturday as Hoboken, New Jersey celebrated its 25th annual St. Patrick’s Day Parade. Though the holiday falls on March 17, there was no lack of Irish spirit amidst this frenzied town.

A stroll down Washington Street at 9 a.m. revealed blocks of already crowded bars, some charging up to $50 for entrance. With the temperature in the upper 50s, thousands set out in their short-sleeved, green apparel for the parade at 1 p.m. A staggering man trying to give away his pizza greeted Edward Gars, a regular parade attendee and student at Rutgers University, outside Sullivan’s Bar.

Though he jokes about the increased likelihood of "roofied" pizza, Gars enjoys the hectic atmosphere. “Everyone makes a fool of themselves and no one cares,” said Gars. “And I love the green pizza.” Benny Todinos, a local pizza shop, baked green food coloring into the crust, a simple color change that results in a line extended down the block.

The enthusiasm for the parade was not limited to New Jersey inhabitants, however. Jessica Brown, a junior at NYU, took the PATH train the night before to stay with friends in anticipation of the festivities. “I love everyone getting out on the street,” said Brown. “From little kids with bobbing clovers on their heads, to drunken youth, all the way to the die-hard men in those awesome Irish outfits.”

Some parade goers did not reciprocate the crowd’s sentiments for the festival. “I remember liking parades when I was younger,” said Sam Crown, a resident of Hoboken for 33 years, “but I thought it was too much for me—too noisy, too many kids drinking, and just not as enjoyable as I had hoped.”

Handwritten advertisement for bathroom at St. Patrick's Day Parade

Though opinion on the celebration is bipolarized, public drunkenness has posed a problem in Hoboken during past parades. Mayor Dawn Zimmer imposed a “zero-tolerance” policy on public drinking, public urination, disorderliness and unruly house parties, resulting in a number of advertisements for costly apartment bathrooms. Despite the risk of confirmed fines of up to $2000 and mandated community service, police sirens sounded throughout the day.

Christopher Edward, a senior at Stevens Institute of Technology, commented on the aftereffects of the day’s events. His apartment complex, littered with half-empty beer bottles and shattered glass, echoed with the noise of various parties. Despite returning home to a now “tad messy” residence, his first experience with the Hoboken parade is positive. “It was pretty cool how everybody, even though not Irish, felt like a part of a group that had something in common,” said Edward. “The alcohol infused atmosphere was definitely very relaxing.”

A 16-year-old at the High School of Fashion Industries in Chelsea was in desperate need of birth control pills and a free pregnancy test, but couldn’t bear to go back to the neighborhood walk-in clinic she had fled days before. The waiting room full of married couples intimidated her. “I went inside and saw the people, and I was like, I’m not doing this,” she said. “Not here.”

Her need for access to contraceptives is not unusual for New York teenagers. Statistics collected by the Guttmacher Institute show that 13 percent of teens have had sex by age 15, a number that jumps to 70 percent before they turn 20. Although confidential clinics are available throughout the city, navigating the medical system can be overwhelming for a teenager without help from an adult. The junior at Fashion, Carolina, who declined to share her last name, said that to ask her mother would have meant confessing that she was sexually active, which she, like so many teen-aged girls, wanted to avoid.

But embarrassment is not the only deterrent for teenagers who need professional counsel, both to choose the right method of birth control and then obtain it. A position paper from the Society for Adolescent Medicine points out that technical issues such as billing, notifications, and reimbursement procedures can be just as overwhelming to an adolescent. This was Carolina’s experience. “The thing about it is, in an outside clinic, you have to put down your information, and you have to open up an account,” she said. “They said my parents might find out through the insurance. So I didn’t want to deal with that.” All of these factors inadvertently conspire to promote unsafe sex among teens and and can lead to pregnancy-related dropouts.

For the past 45 years, both the New York Department of Health and the Department of Education have been working to address the issue of teen pregnancy in the city’s five boroughs. The latest iteration lets girls like Carolina turn to their school’s health center for comprehensive and confidential reproductive services. CATCH, short for Connecting Adolescents to Comprehensive Health Care, links sex education to safe sex practices. It began in January 2011 at five schools with high pregnancy-related dropout rates that happen to be located in neighborhoods that offer few, if any, related services.

The program got off to an inauspicious start. Parents reacted vociferously to an article in the New York Post that zoomed in on the inadequate way the schools had gone about informing parents about the project. On top of that, the health department and the Department of Education have shown reluctance to be transparent about the plan with inquiring parents or with the media. In response to inquiries over the past eight months, neither department has been forthcoming about the project despite repeated requests for interviews or for replies to written questions.

Bad press and parental brouhaha aside, results at the initial five schools in the pilot were promising enough for CATCH to expand to eight more schools at the beginning of the 2012-2013 school year. Under the program’s provisions, students who ask -- and whose parents have not opted them out of participation -- can receive pregnancy tests, condoms, and other forms of birth control, including Plan B. The program also offers education on contraceptive methods and provides referrals to outside, teen-friendly clinics. It makes all these services available without cost or parental permission.

But this is the Catch-22 that caused the negative reaction at the outset: Parents who never receive notice of a new school program are not in much of a position to opt their children out of it. When CATCH began, participating schools chose to inform parents by sending an informational opt-out letter home with freshmen in their orientation packets. Students in the upper grades also got a letter to take home. The inevitable non-delivery meant, in effect, that first word of the program for many parents came from the Post. “NYC Schools Give Out Morning-After Pills to Students—Without Telling Parents” was the inflammatory headline that appeared 18 days after classes began in September 2012. Parents organizations responded swiftly, speaking out against CATCH in televised interviews and at a protest on the steps of City Hall.

While some of the initial fury has since subsided, the program continues to generate controversy. One underlying issue is the assumed control parents believe they should have on what the sexual rights of adolescents are or should be. Another is a newly critical examination the pilot project has spawned: how city government handles the sensitive issue of sex education for its youth.

* * *

While CATCH may be the city’s first teen pregnancy-related program to distribute medication, New York for decades has been devising strategies aimed at reducing teen pregnancy rates and keeping pregnant teens in schools. One of the more ambitious of these efforts came between 1967 and 1970, when New York established six schools for pregnant teens and teen mothers. “P-Schools,” as they were called, were separate from other public high schools and made it possible for pregnant girls to finish high school. The schools offered parenting classes and access to vocational resources. Most the schools also offered day care service in their buildings.

The schools failed, plagued by low attendance, poor test scores, and inadequate facilities. The program ended in 2007 to the relief of administrators and students who had been in the program and found it stigmatizing to be forced into separation from their peers. As Cami Anderson told New York Times when the program folded, “It’s a separate but unequal program. The girls get pushed out of their original high schools, they don’t come to class, and they don’t gain ground in terms of credits.” At the time, Anderson was the city’s superintendent of nontraditional schools.

CATCH is not the first time the Departments of Health and Education teamed up to address teen pregnancy as it relates to school dropout rates. In the early 1980s, they created LYFE, which stands for Living for the Young Family Through Education. Under this plan, rather than separating teen mothers from their peers, LYFE encourages students to continue their education as they normally would with the help of free childcare centers, academic support, and advocacy services.

LYFE is still functioning, operating out of 37 sites across all five boroughs structured along New York State’s Early Learning Guidelines. The children continue to receive instruction until they are old enough to transfer into a preschool.This gives the teen mothers time to receive their high school diplomas or GEDs. Informal student surveys show a positive response. In 1988, the New York Times reported that 90 percent of the 73 students interviewed said LYFE made them feel better about themselves and provided strong support for their desire to finish school. Since then, there has been little in-depth reporting on LYFE, but the program has been mentioned through the years as an important support force for school-aged mothers.

But neither the ill-fated P-Schools or LYFE addressed the issue of early pregnancy prevention. So in 2006, New York launched another program, the Healthy Teens Initiative, which provides clinicians with “tools, resources, and technical assistance to support sexual and reproductive health services for adolescents.” It promotes seven healthy steps to follow, such as ensuring adolescents confidentiality in their reproductive choices and care, creating a welcoming atmosphere in clinics, and providing contraceptive services to sexually active teenagers. The point is to combat the fears that teenagers, like Carolina, experience when they walk into health clinics with little understanding of their rights and options. It seems to provide the basic groundwork for what the CATCH program would later offer within the school-based health centers.

Because of such successful early initiatives, including earlier sex education and increased availability of condoms, teenage pregnancy rates have steadily declined locally, mirroring the national trend. Across the United States, between 1972 and 1990, teenage pregnancy rates dropped 25 percent, according to Kristen Luker in When Sex Goes To School. Luker teaches sociology at the University of California at Berkeley. In New York, the Department of Health reports that the teenage pregnancy rate has dropped 27 percent in the last decade alone. In the face of so much progress, it’s reasonable to wonder why we need programs like CATCH at all.

Statistical improvement aside, the reality remains grim. The health department reported in an email that in 2011, some 7,000 girls under the age of 17 got pregnant in New York City alone. Of those, 90 percent of the pregnancies were unplanned, and 64 percent of all teen pregnancies ended in abortion. Of the total number of 7,000 girls, a third of them, 2,200, became mothers, and 70 percent of those new parents dropped out of school. Hence, the impetus for yet another initiative, for CATCH.

While the Department of Health emphasizes CATCH’s socio-economic targeting, its reach in this early phase also has, perhaps not by design, a racial and ethnic complexion. This triggered a charge of racism from the president of the city’s Parent Union, Mona Davids. The demographics of the 13 schools now involved show that more than 96 percent of their aggregate student bodies identify as members of minority groups: 8.9 percent Asian, 37.4 percent Black and 49.4 percent Hispanic. (One of the schools, Adlai E. Steven Campus in the Bronx, is not included in the statistics due to multiple campuses.)

Chart shows demographics of students in CATCH schools.

The figures derive from a 2011-2012 demographic snapshot compiled by the Department of Education. In additional to Fashion High and Adlai Stevenson, the pilot schools identified by the health department are: Grace Dodge in The Bronx, Boys and Girls, Clara Barton, W.H. Maxwell Career and Technical Education, Abraham Lincoln and Paul Robeson in Brooklyn, John Adams, Newcomers, Queens Vocational and Technical, and Voyages in Queens, and Port Richmond on Staten Island.

In September 2012, CNN featured Davids of the Parents Union in a debate with Deborah Kaplan, who is the health department’s assistant commissioner for maternal, infant and reproductive health. Davids argued that “the Department of Education has no right whatsoever to give any child a chemical, hormonal cocktail—a drug—when they can’t even give a child an aspirin in the schools without the parent’s permission.” To this, Kaplan countered: “Although we totally encourage them and believe it’s so critical that [students] talk to their parents, not all young people can or feel that they can, and yet they’re sexually active.”

In a more private conference, the Department of Health met with the NYC Parents Choice Coalition to discuss its questions and objections to the program. However, Greg Pfundstein, a member of the coalition and the executive director of New York City's Chiaroscuro Foundation, said the meeting didn’t fully address any of the issues and, at one point, as the coalition’s parents pressed for answers, the health department’s representatives threatened to walk out.

As the fall progressed, the voluntary and governmental relief efforts following Superstorm Sandy took precedence over the birth control debate. CATCH receded from the headlines, but only temporarily. On Feb. 2, 2013, the New York Postreported, using information obtained under a Freedom of Information Act request, that the public schools were handing out “tens of thousands of doses of the morning-after pill.”

The Post said that about 40 separate school-based health centers had distributed 12,721 prescriptions for Plan B between 2011 and 2012. These numbers contradict the announcement officials gave last September when the Department of Health reported that only 567 girls had received Plan B. Also, the health department did not disclose the names of any of the schools involved other than the 13 in the CATCH program. The Post summarized this news in one snarky line: “Plan B has become Plan A in the Bloomberg administration’s stealth war on teen pregnancy.”

Although the Post has helped highlight many of the issues surrounding the CATCH pilot, Dr. John Santelli, a pediatrician and adolescent medicine specialist, thinks the Post piece was overly dramatic and “misrepresented the facts.” Santelli also chairs the Heilbrunn Department of Population and Family Health at the Mailman School of Public Health at Columbia University and is a member of Physicians for Reproductive Choice and Health. “The CATCH program and other programs in school clinics provided information samples to parents,” he said. “But the Post tried to make it a controversy where I don’t think there necessarily was one.”

* * *

The merits of CATCH aside, the controversy it has generated raises a number of concerns that pit parents against schools in the sensitive issues surrounding the reproductive rights of adolescents. Do the opt-out statistics really reflect parental support? Is it safe to not tell parents what prescriptions their children are taking? Will the pill encourage reckless sexual activity?

Luker writes in When Sex Goes to School that not involving parents in the decision-making process is a fatal flaw when it comes to sex education. In her view, “educational authorities should consult parents with children in the affected schools more assiduously than they consult people who want to use the school to make a larger political or moral point.”

Laura Timoney is the mother of a 14-year-old daughter and president of the Parents Union’s Staten Island chapter. She is one of CATCH’s opponents, largely on grounds of the lack of parental involvement in the program’s creation and implementation. “Apparently,” Timoney said, “they’ve had this program since January 2011, and September is just when it came to light when they were rolling it out to more and more schools.”

Heather Boonstra, a senior public policy associate at the Guttmacher Institute, was less critical of the approach the schools took to informing the parents. “I know a lot of information like this is lost in translation,” she said. “But as long as schools are doing what they can do to try to make parents aware and give them the chance to opt out of the program for their adolescence, I think that’s the right way to go.”

In the view of Sally Guttmacher, a professor of public health at New York University, how schools go about informing parents is less an issue than the level of parental interest and involvement. Her own research includes a study of condom availability in schools in South Africa. Similar to CATCH, that program had an opt-out provision, in which the schools administrators notified parents to contact them if they did not want their child to have access to the program. Guttmacher then interviewed parents to see how many of them actually remembered hearing about the program. Very few did.

“It’s very complex because lot of parents are just not all that interested about what’s going on, and that’s the problem,” Guttmacher said. “It’s very hard to reach those parents. We offered incentives and raffles and all sorts of things like that, and it was still very hard.”

While it’s true that many parents don’t pay attention to what goes on at their children’s schools, Amal Biscaino, mother to another junior at Fashion High, thinks that blaming the parents is a cop out. “To be honest,” she said, “I read all the newsletters that are sent home. I’m very involved. I know my daughter’s guidance counselor. And I don’t ever remember receiving any information on it at all. Maybe I over-glanced it or didn’t take it seriously, but I feel like if this was one of the school’s chosen to roll out this pilot or this particular program. Why didn’t I know about it?”

If a parent doesn’t know about a field trip, the child can’t go. Pfundstein, who only learned about CATCH when a New York Times reporter called him for comment on the Post’s news break, believes the same should be true for a project to disseminate birth control in the schools. That is why he and the NYC Parents Choice Coalition are advocating a change in the program’s format from parental opt-out to opt-in.

As the mother of a teenager, Timoney is not opposed to teenagers using birth control if the parent is “cool with that,” but she agrees with Pfundstein. “My daughter goes to high school out here in Staten Island, and they do have a health affiliation with Staten Island University Hospital, not just the nurses. The nurse actually can’t even give her an aspirin without my permission,” she said. “The fact that they can give a 14-year-old the Plan B pill after having unprotected sex and that it’s an opt-out program, not an opt-in program, are really at the core of what is bothering us.”

But the Department of Health argues that CATCH’s low opt-out rate of only 1 to 2 percent of the parents involved, shows that the majority of parents don’t mind that their teenagers have access to the program. Opponents think this statistic is meaningless, since so few of the parents were even aware the program existed.

To test this theory, Pfundstein’s Chiaroscuro Foundation commissioned a poll for The NYC Parents Choice Coalition in October of 2012. It surveyed 600 New York registered voters in the city to ask their opinions about the principles of CATCH. Some 53 percent of respondents said New York should not be distributing Plan B through its public schools. When asked if the health department should be able to dispense Plan B to children in the public schools without parents permission, 54 percent indicated no.

An outside polling firm conducted the survey under Pfundstein’s personal direction. To prevent skepticism about the poll’s integrity, the firm conducting the survey was not made aware of the coalition’s stance on the issue. “It wasn’t as if we just asked a bunch of people we know,” he said.

But regardless of the survey’s results, Boonstra of the Guttmacher Institute thinks CATCH really needs an opt-out setup because of the burden it places on parents to say no to these kinds of services. What’s important, she said, is that as many young people as possible have access to confidential services. This helps prevent unintended pregnancies and protects teenagers from HIV and other sexually transmitted infections. “These are all very important personal matters and public health matters,” she said.

Other health educators interviewed agreed, adding that the opt-out structure is geared to the uninvolved parent -- the parent who likely won’t be there to ensure their child receives the services that CATCH offers by other means.

Despite the support some parents like Biscaino express for the purpose of a program like CATCH, the lack of information the school provided stands in the way of her otherwise wholehearted endorsement. “You got parents who are going to read up on this and voice their opinions, and then you got parents that don’t know any better,” she said. “And if you don’t opt-out, they’re automatically in, and it’s up to the kids to decide what they want to do.

“But as an educated parent,” she went on, “I would want to have that in place for my child if they ever need it. I mean we have access to these things. And someone could argue, well, now that kids know that the morning-after pill is available at their school that the school is letting them be frivolous or sexually active. But kids will do whatever they want anyway. This is just the era -- the day and time. There’s nothing you can do. So I agree to that. I would sign on for my daughter so, if she ever got in that sort of trouble, she would know that she had options. That’s my educated point of view.”

Biscaino, who is a devout Muslim, is unique in the sense that she favors an opt-in program but insists that she would allow her own daughter to be opted-in. Most parents who say they favor an opt-in approach would opt their own children out. As Luker writes in When Sex Goes to School,

We expect certain kinds of values to cluster together. We generally expect people who call themselves Christian to be be on the conservative side, both politically and sexually, just as we expect people who fit the profile of secular humanists to be liberals, in the bedroom and elsewhere.

Millie Colon is the former parent coordinator at Fashion High and an active member of its parents association and its Title 1 Parents Committee. One of her daughters is a senior at the school and her older daughter has already graduated. “My personal feelings are kind of 50-50,” she said. “While I personally opted for my daughter to not be part of the program -- I have a good relationship with my child and, should my child try to do anything, she would come to me -- other students don’t have a good relationship with their parents.”

Indeed, many parents who are equivocal about the program assume that it is directed at teenagers who are not close to their parents. They believe their own children are either not having sex or would feel comfortable enough to come to their parents for help if they needed it.

Carolina said that this assumption is incorrect. She estimates that about 95 percent of her 16 to 17-year-old friends are having sex, “and no one tells their parents.”

This unscientific assessment concurs with the findings of Sinikka Elliot, an assistant sociology professor at the North Carolina State University in Raleigh. In her 2012 book, Not My Kid: What Parents Believe about the Sex Lives of Their Teenagers, her subjects not only refrain from telling their parents that they are sexually active, but their parents don’t even suspect the possibility that they might be. Her study of 47 parents revealed that most of them believed their children to be fairly naive and innocent when it comes to sex, but they assumed otherwise about other people’s children. So, if Elliot’s data is correct, it follows that if parents are choosing to opt their teenagers out of CATCH purely on the basis of assumed sexual activity, they will most likely be wrong.

Furthermore, while mutual decision-making between parent and child is ideal when it comes to adolescent reproductive health issues, statistics show that parental involvement actually decreases the chances that teens will seek these services. The results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls shows that 35 percent of students who did not seek care gave as a reason the desire not to tell their parents.

Confidentiality is key.

Another study looked at the effect of mandatory parental notification on sexually active single girls under the age of 18. They were surveyed in family planning centers. Half of them said they would stop using birth control if there was any possibility their parents would be notified. An additional 12 percent said the same about sexually transmitted infection tests. However, only 1 percent of these girls said they would actually stop having sex if they no longer felt comfortable using these services.

But parental rights is not the only issue to activists like Pfundstein and Timoney. “This is a chemical, hormonal mix that they’re giving these kids, and you don’t really know what the long-term side effects are,” Timoney said. “And if the parent doesn’t know, and there is some serious side effect, like an ectopic pregnancy or severe cramping, and you don’t know your child has this, you might not take your child to the emergency room,” she said. ”You might just say, ‘Oh, you’re having a bad period. You need to stay home from school today,’ which can be extremely dangerous.”

Pfundstein posed a similar hypothetical: A girl can receive Plan B at the school’s health center without parental permission. And though Plan B is proven to be safe long-term, its side-effects are similar to that of the flu. “So then she ends up nauseous and vomiting,” he went on,” and she comes back to the nurse and she says, ‘I feel sick.’ And the nurse can’t give her Dramamine or anything else. All she could have given her was the Plan B.” That is because nurses aren’t allowed to administer any medication without parental permission, except for those drugs provided through CATCH. “So they have to call the parent and the parent comes in and picks up the kid, and they know exactly why she’s sick -- because she took Plan B in the morning,” Pfundstein said. “But they can’t tell the parent anything. So nobody knows.”

The types of birth control CATCH offers also has the parents riled. First, there is a rampant misconception that Plan B is an abortion pill. Dr. Kellie Bryant, of the NYU College of Nursing was adamant in proclaiming this untrue. She is also a women’s health nurse practitioner at Jamaica Hospital Women’s Health Center. Other parents have raised concern about Depo Provera, an option that only became available to students this fall.

“When I researched the Depo Provera shot, I learned it’s the same shot that’s also used to chemically castrate males,” said Timoney. “So maybe we make it Plan A and give guys in high school the shot, and we won’t have any problems, will we? That’s a silly thought. But it’s okay if it’s girls, and this is the same dose, same everything that they’re using on convicted pedophiles in prison.”

While Dr. Bryant supports CATCH and the opt-out setup, noting that she can already give out birth control without parental consent to girls as young as 12, she agrees that Depo Provera may not be ideal for teenagers. But her reason is different than Timoney’s. Long term, she said, Depo can decrease bone mass. “For someone who’s a growing teen, I’d be concerned because that’s when they’re going to build their bone mass the most,” she said. “I’ve had patients in their 30s that have had Osteoporosis already because of Depo.”

Depo-Provera Injection

Dr. Bryant believes birth control pills to be the best option for most teenagers. However, like most medical decisions, it depends on the person’s individual needs and should be decided upon with the assistance of a medical care provider.

Many parents also wondered why no statistics were provided to show that the earliest CATCH pilot worked before the next eight schools were added to the project. As Pfundstein lamented in an e-mail, “The Department of Education specifically told us that they were making no effort to track the program's effect on rates of teen pregnancy. They told us that they considered the program a success simply because students came in and got pills. In my line of work, a program with such complete lack of accountability would never be funded.” Questioned about Pfundstein’s comments, the Board of Education referred all questions to the Department of Health, which offered no comment.

Guttmacher, who helped with the evaluation of New York’s Condom Availability Program in the early 1990s, said that while it may seem obvious to measure CATCH’s effect on pregnancy rates, it’s not that easy to do. Many teens get abortions and don’t feel obliged to report their pregnancies, resulting in a severely underestimated count. “Measuring it in terms of how much medication is being given out? I guess that’s one way to measure it to see how useful the program is,” she said. “The better measure is obviously to see how many pregnancies were avoided but that’s really hard to measure.”

As for the students, only a few brave ones, like Carolina, would talk openly for publication about birth control. She believes that it’s just a fact of life and talking about it, unlike sharing sexcapades, is just a medical conversation.

She and other students interviewed about CATCH have had many positive experiences with the pilot program, and all of them report that the process was fairly simple. “I went to the office, and I was going to ask the nurse how I could get on birth control at the school,” said Carolina. “And she said, ‘Oh, the doctor’s here today.’ It just happened that the doctor was there that day, and I think the days he’s there are the days he can get the birth control. So [the nurse] said, ‘Go take the pregnancy test. And after the pregnancy test, we’ll let you know. And then he’ll examine you to see if you’re able to get birth control.’ He examined me, and then I came back next month to pick it up.”

Carolina also says that the nurses were very informative. “They told me about different types of birth control. They have a sex counselor. And they showed you all the options,” she said. “They showed you how to put stuff on, like the ring.”

A junior at Clara Barton named Chyna said that it’s easy to get an appointment for CATCH services, and the program really helped her friend who found out she had an STD. “She doesn’t know what she’s going to do yet but at least she’s thinking about it,” she said. Chyna further noted that it was unlikely her friend would have gone somewhere else for the test.

Among the students interviewed, many obviously found it easier to discuss the experiences and attitudes of unnamed friends than to talk about their own. Jezereel, a sophomore at Clara Barton, said she also has a friend involved with CATCH. “She’s having sex so she’s going to the program. They know they can’t stop her from having sex so they’re giving her birth control and condoms. I mean, if she doesn’t want to stop doing it, they might as well protect her.”

Unlike parents, however, the majority of teens who said they were not sexually active still think that CATCH is important for their peers. Kishema, a sophomore at John Adams High School, said that although she and her friends have no current need for birth control or Plan B, she has no doubt that a lot of students do. “It seems like a good idea for potentially those who are active and who need to be prepared. I wouldn't have knowledge of or use of it anytime soon since the abstinent don’t need it, but it's good that the school does help the students this way who are active because things will happen and everyone is different.”

A freshman at Clara Barton named Abby said that, although she doesn’t use the program herself, she has spoken with its nurses. “They taught me me a lot about how to protect myself and, not just sex, but how to say no to other things, like drugs, alcohol, and things like that. It’s a full-education experience,” she said. “It’s like preparing someone for war. You don’t want them going into battle not knowing what to do.”

An unintended but obvious benefit of the program is that it discourages teens from stealing pregnancy tests from local pharmacies. “That way if anyone ever gets scared, they don’t have to go to freaking Rite-Aid to steal one,” said Carolina. “Because before the program, I knew a few girls who go in and steal stuff just to check. Now that it’s at the school, no one has to go do that.” A 2012 survey by the National Retail Foundation showed that pregnancy tests are among the top three most purloined items in the health and beauty category.

There’ve been efforts to cheat the CATCH system, too. Alana, a student at Boys and Girls High School, tried to obtain birth control on behalf of a friend whose mother had opted her out of the program. ”I went in there and asked for a birth control pill, and they asked if I was having sex,” she said. “I said, ‘Yes,’ even though I wasn’t. I had to pee and do extra stuff. They didn’t give it to me because I really didn’t know what to say. They asked when was the last time I had my period. I said like a long time ago, and they said they couldn’t give it to me.” But Alana said another friend of hers successfully used CATCH to get Plan B for her brother’s girlfriend who attends a different school. She said she knew of several similar situations.

The program is designed to make sex safer, but does the easy availability of contraception make teens more inclined to have sex earlier too? Guttmacher says that from her experience with the Condom Availability Program, the answer is no. “One of the things before they put that program into effect was that there was a huge uproar in the city with some parents and some religious folks, thinking that if you make condoms available in the school, you’re going to send kids into a wild sexual frenzy. And in fact, that did not happen,” she said. “The people that used the program, and the program should still exist, were kids that were already sexually active.”

But the easier access to birth control pills and PIan B may also encourage riskier sexual practices by lessening the the pressure to wear condoms because for most teens, pregnancy, not STIs, is the No. 1 concern. “Do we just give them the Plan B pill and say, ‘Have a nice day?’” Timoney asked. “I think this is just a one-off, after-the-fact plan that could easily contribute to increased number of sexually transmitted diseases and increased numbers of HIV cases because you’re going to have more unprotected sex.”

Carolina mostly agreed. In her circle of friends, no one likes using condoms when they are otherwise protected from pregnancy, even though they know it’s stupid. “There’s still STDs and stuff,” she said, “but they just think about getting pregnant.”

Bryant, the nurse-practitioner, also agrees there is a great risk of contracting sexually transmitted diseases when teenagers have freer access to birth control. But she also believes the benefits of easier access outweigh the risks. “But there’s no right answer.”

* * *

Advocates and opponents alike acknowledge that pregnancy rates are dropping, down 27 percent in New York over the last decade. This news, which came conveniently in the midst of the CATCH controversy this past February, cannot be completely attributed to the program, as it started in 2011. However, the Department of Health alluded to the fact that CATCH is playing a part. “Two things are happening here — teens are using more contraceptives, and they’re also delaying sexual activity,” said Health Commissioner Thomas Farley to the New York Daily News.

Farley’s conclusions derive from the 26 percent drop in sexual activity among public high school students, from 50.9 percent to 37.8 percent. Also, the percentage of girls who reported using the Pill or another long-term birth control method the last time they had sex rose from 17.3 percent in 2009 to 26.9 percent in 2011 (data was not measured before 2009).

Despite progress from increasing sex education and programs like LYFE and CATCH, New York is still not giving up on finding new ways to prevent teen pregnancy, each causing as much controversy as the last. Early this March, the New York Human Resources Administration launched an advertising campaign advising teens not to have sex before marriage. Sad faces of babies, mostly babies of color, look out from posters on the subway, saying things like “Dad, you'll be paying to support me for the next 20 years” and “Honestly Mom... chances are he won’t stay with you. What happens to me?” Facts about teen pregnancy follow with an an invitation to text “Not Now” to a certain number for more information on the “price of teen pregnancy.” Unsurprisingly, this campaign is also receiving flack but not for the same reason as CATCH. Instead, there are objections to the way the posters seem to clearly advocate abstinence and cast a shadow of shame onto teen mothers.

Teen Pregnancy Prevention posters from the HRA.

The health department has even more recently launched an app called “Teens in NYC Protection+” that provides teenagers with sexual and reproductive information, such as health statistics and where they can go to access free clinics.

The federal government is also on the case, having made the most drastic move of all. On April 5, 2013, Judge Edward R. Korman of the Federal District Court ruled that the morning-after-pill, Plan B, should be available over the counter for women of all ages. The Food and Drug Administration had 30 days to comply with this mandate. While this doesn’t change CATCH policy, it does make it harder for opponents of the program to argue that the age of the student is a reason to exclude Plan B from the birth control options offered in high schools.

This move alongside New York’s own steps to provide teenagers more access to contraception, indicates that CATCH may well be here to stay. Or at least, advocates like Boonstra of the Guttmacher Institute hope so. Public support for continuing the program is critical, she said, “to get young people not only the information they need but also help them actually act on the education by providing a trusted health care.”

Boonstra also believes that although the program is especially suited more liberal cities like New York, it has the opportunity to thrive in other places. “I think there is support throughout the nation for supported teen pregnancy,” she said. “I think the American public really recognized that young women and young men who experience unintended pregnancy are set back in a number of ways, in terms of their own education, their job prospects, and their child’s development. I think there is support for programs that work that get young people the young people and services that they need.”

With a new federal mandate allowing teenagers of all ages to get Plan B over the counter, CATCH now has even more opportunity to spread. But this is heavily dependent on the city administrations’ ability to cooperate with parents and to communicate with them more openly, effectively, and transparently. And, as always, on the ability of parents to accept the sexual realities of their teenaged children.

When Joseph Tepper was 10 years old, he went snorkeling at his hotel in Hawaii. Scared by the 6-feet of water in the pool, he insisted that the instructor give him a life vest. Days later, he was crawling out from the ocean with 60 pounds of scuba diving gear strapped to his bony back.

Tepper, who has completed more than 1500 dives since that day, won third place in Nov. 2012 for his underwater photography in the Festival Mondial in Marseille, which “is like the Academy Awards of underwater film making and photography,” says Tepper. Last year, Tepper won the Young Underwater Photographer Award, which earned him a paid trip back to Hawaii in March 2013 for an underwater photography shoot and connections with the field’s leading photographers at magazines like National Geographic, and the Cayman Free Press Award. Tepper is also a full-time journalism and anthropology student at New York University, an associate editor for DivePhotoGuide.com (the leading media in underwater photography), a photojournalist for Scuba Diver (DivePhotoGuide.com’s magazine counterpart) and a contributing writer for The Daily News.

Tepper, however, quickly shrugs off the scope of his accomplishments. “I deal with photographers who win every single competition. Some of my best friends in the industry and some of my closest colleagues have won hundreds of competitions,” said Tepper.

From colleagues to those closest to Tepper, all have all taken note of his modest attitude towards life. “He’s not full of himself,” explains Tepper’s father, David. “It’s interesting because he has so many talents, gifts and accomplishments, but he’s just very normal in most respects.”

Nick Young, who has been close to Tepper since they met at their high school, freshmen orientation at North Shore Country Day School in Chicago in 2005, describes Tepper as “light-hearted and eclectic.” “He’s got so many different talents and things that are just really important to him and they just don’t intercept at all, like magic stuff [Tepper performs card tricks], how much he loves baseball, how much he loves hockey and the diving stuff and the singing. It’s all over the place,” says Young.

Despite his success in underwater photography, Young says that Tepper rarely shares more than brief anecdotes of his time in the water: “He’s a pretty humble guy. He doesn’t walk around talking about the fact that he’s basically a prodigy.”

Tepper’s humility can be partially attributed to the years of hard work he put into his underwater photography before he considered going professional. In fact, Tepper learned to dive before he ever wielded a commercial camera. “On my first dive, I bought a little, goofy, disposable, Kodak camera and did that for about two to three years,” says Tepper. “Then, for my 14th birthday when I got certified, my mom finally got me a nicer, higher-end camera. Nothing special, but it wasn’t disposable.”

On Tepper’s 18th birthday in the summer 2009, his mom finally invested in a commercial grade underwater camera. Shortly after, he experienced a fortuitous career break while surfing DivePhotoGuide.com.

“It is one of the most well-known sites in the underwater photography world, and I was on the website, just like you’d be on Facebook, and they sent out a call to see if there were any writers. Just writers looking to do news stories,” says Tepper. “So I sent the editor a sample of my writing and my photos—though I didn’t have to because it was just a writing thing. He liked my writing, knew I could edit and liked my shooting, so he brought me on board as the associate editor. And since then, I’ve really grown.”

Through his connections at DivePhotoGuide.com, Tepper has steadily earned the love and respect of other divers and underwater photographers across the world. Allison Vitsky, an underwater photographer and photojournalist from California, has noticed his rapid development in the field.

“The stuff I’ve seen from him in probably the last year… the improvement is phenomenal,” says Vitsky. “I don’t know what happened, but he hit on something that just made his stuff just get exponentially better almost over night. It was really neat to see that, especially because he’s so young and in school full-time, so I know he’s not out diving every weekend like we are [her and husband].”

Part of what makes Tepper’s photography so unique, according to Vitsky, is that he does a lot of self-modeling. Modeling in underwater photography is the process of using a person in the background of your image to provide scale to the subject, be it a shipwreck or a clownfish. Instead of always using other people, Tepper will often set up his tripod underwater and swim to the right position in time for the shot. “Not a lot of other photographers would have the wherewithal or the tolerance to do that,” says Vitsky.

Vitsky met Tepper, who she now endearingly describes as “the best kind of smartass—sarcastic in a sweet way,” when she hesitantly accepted an email request from him to dive with her and her husband in San Diego. The water in California is much colder than in the Caribbean, which can be dangerous to divers who are only familiar with warm waters. “He comes out and he gets in the water, and it’s like he’s always been here. He’s an incredibly awesome diver, and he’s just really relaxed,” says Vitsky.

The goal of Tepper’s dive was to see the sea lions, but instead they witnessed an entire school of sardines circle them for almost two hours. “I got out of the water and apologized to Joe, and he was just laughing and really excited and saying, ‘Oh, that was one of the most amazing things I’ve ever seen,’” says Vitsky. “And that’s one of the things I’ll never forgot about Joe, knowing that he had that attitude. I just remember thinking that this a great kid, and he’s really going to make his mark in it if he wants to.”

On that same trip to California, Tepper, who considers himself a little bit of a hypochondriac, believed he had the “Bends,” a rare illness medically known as Decompression Sickness. The ailment is caused by air bubbles in the blood that expand due to pressure when the diver comes up towards the surface of the water. If he or she comes up too fast, the air bubbles expand at a rate that can’t be diffused through the body, which can cause anything from joint pain and rashes to paralysis and death.

Tepper was alerted by his sore shoulders, a common starting point of the illness’ symptoms, and the cold, Pacific water, which is more conducive to the illness. “I’m a dive master, so I’m trained to know the signs of it, so it can be very nerve wrecking. You just come up from a dive and wait to see if the symptoms happen or don’t happen,” says Tepper.

Unbeknownst to his diving companions, Tepper checked himself into a hospital in San Diego that specializes in the rare illness. He was cleared after extensive testing but never shared his suspicion. “I guess he didn’t want to worry us,” says Vitsky, who first heard of the incident upon questioning of the accident. “Tell him, ‘shame on him.’”

While Tepper has confronted sharks, komodo dragons and crocodiles, the Bends remains one of his biggest diving fears. “In some ways, dying is preferable to living your whole life with paralysis or living your whole never able to dive again,” says Tepper.

While many of his friends wonder how the same guy that sings musicals can swim intrepidly with sharks, Tepper insists them that underwater photography is not that extreme. “I think people tend to think of diving as a thrill seeking thing, like jumping out of a plane, when it’s really not. So, for me, a scary moment is something like when I’m 90 feet down and I can feel my tank empty,” says Tepper.

Cara Brockman, Tepper’s live-in girlfriend, explains that Tepper’s time in the water is less about bravado and more about a few hours of serenity. “While on the outside it might seem that Joe has an extremely laid back personality, people close to him know that isn't always the case,” says Brockman. “He cares very much about things that are important to him, and sometimes that puts added pressure on him. In fact, Joe doesn't consider diving an extreme activity. Often times, he feels very tense, and diving helps him to relax.”

But diving is more than an escape from the day-to-day activities. As an underwater photographer, the ocean is often a break from people altogether. “As a photographer, you do a lot of diving alone,” says Tepper. “You go into the water with other people, but you want to photograph a tiny, little shrimp for 45 minutes. Everyone else is like, ‘Screw that, I’m going to see this beautiful wall of coral.’ So everyone swims off and you can be on your own at 60 to 80 feet.”

Susan Klingenstein, Tepper’s mother, says that while Tepper tells her very little about the competitions he enters and the awards she wins, she knew that diving was becoming serious for him when he continued to beg year after year to spend each spring break somewhere he could get in the ocean. But his skills at underwater photography, according to Klingenstein, have less to do with his personality and more to do with his general determination.

“When he tries something, he always does it to completion,” says Klingenstein. “He’s just always wanted to do things on his own. He’s always just wanted to—not prove himself—but show that he knows how to do something. He’s done that since he was a little.”

Tepper’s father agrees: “If it’s something that he’s set his mind on, he’ll just work at it methodically until he’s perfected it.”